Provider Demographics
NPI:1750596607
Name:LIEBERMAN, JORDAN (MD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCHC C/O NJ DOC, WHITTLESEY RD & STUYVESANT AVE
Mailing Address - Street 2:BATES BUILDING, 2ND FLOOR
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08625-0863
Mailing Address - Country:US
Mailing Address - Phone:609-292-9700
Mailing Address - Fax:
Practice Address - Street 1:UCHC C/O NJ DOC, WHITTLESEY RD & STUYVESANT AVE
Practice Address - Street 2:BATES BUILDING, 2ND FLOOR
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08625-0863
Practice Address - Country:US
Practice Address - Phone:609-292-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044764L2084P0800X
NJ25MA059253002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry